Sean Duffy, Co-founder and CEO, Omada Health, Noosheen Hashemi, Founder and CEO, January AI Owen Tripp, Co-founder and Chief Executive Officer, Included Health Moderator: Jennifer Fields, FORTUNE
Category
🤖
TechTranscript
00:00 I'm just going to jump right in.
00:01 I'm going to start with you, Sean.
00:04 We have more awareness of chronic diseases
00:06 than ever before and more drugs to treat them than ever before.
00:09 And yet, we have more sickness than ever before.
00:12 So can you talk about how we got here?
00:14 Why are Americans so sick?
00:15 Yeah, it's a great starter question.
00:17 And it's something I've experienced in founding
00:19 a model where we're 13 years old.
00:22 And every couple of years, I feel
00:23 like I read the exact same JAMA article, which
00:26 is the epidemiology getting worse,
00:28 the disease burden's getting worse,
00:29 the data's getting worse, and that has to change.
00:32 And the thesis that we have is you
00:34 have to support people on a day-to-day basis,
00:37 a proactive day-to-day basis.
00:39 And the entire health care system
00:41 of supporting people every now and then with visits
00:44 just doesn't work for chronic disease.
00:46 And I think that that's a real opportunity for employers
00:49 and why they can get engaged in really
00:51 helping solve the challenge.
00:53 So, Owen, I want to jump over to you.
00:55 There are so many large employers
00:57 who are paying for workplace wellness programs,
00:59 but we also know that workplace wellness programs
01:02 aren't actually working.
01:04 Can you talk a little bit about why they're falling short
01:06 and where?
01:08 I'm going to start with why that's such a crucial problem
01:10 for employers.
01:12 This is the largest expense.
01:14 It's the largest thing that they pay after payroll.
01:17 It is the largest reason why they can't attract workforce
01:20 and they can't maintain that workforce doing the jobs
01:22 that they ask them to do.
01:24 So it is actually a problem of American competitiveness.
01:26 I know we're going to talk about health care over our time
01:28 together, but let's just actually start
01:30 with how desperate this is for our economy and our country.
01:33 Now, why does this happen?
01:35 Well, we invest that money.
01:37 We expect people to find these things on their portal,
01:42 to know how to use them, to engage in health care in ways
01:45 that we in rooms like this design,
01:47 and it just doesn't work.
01:49 Members, patients, whatever you want to call them,
01:51 they want to be treated like complete individuals.
01:53 They don't actually want to think
01:54 in terms of the labels of their diseases.
01:57 They want to be treated for their minds,
01:59 for their bodies, and their wallets.
02:00 And it's companies that pull all those things together
02:02 that are offering the solutions that are winning today.
02:05 That's great.
02:06 And Nusheen, you do a lot of work with AI.
02:09 And I think we all hear a lot about the promise of AI
02:12 in health care.
02:12 Can you talk a little bit about how
02:14 you think AI can help prevent and manage chronic illness?
02:18 Absolutely.
02:18 It's addressing exactly what they both mentioned.
02:22 So often, we're offering generic services to everyone.
02:26 They're not hyper-personalized to each person.
02:28 People are infinitely interested in their own circumstances.
02:31 They don't listen to generic advice very much.
02:33 So I think AI provides that opportunity
02:36 for personalization and getting hyper-personalized,
02:39 for example, looking at someone's data
02:41 and dynamically updating based on, let's say,
02:43 blood test data that comes in, wearable data that comes in,
02:47 being able to essentially help people with everything
02:49 from symptoms tracking to mood tracking to early detection,
02:53 for example, looking at someone's irregular heart rate
02:57 before they even develop symptoms.
02:59 Or providing just-in-time care to people.
03:02 So instead of waiting after someone's already
03:04 eaten something to tell them it wasn't a great idea,
03:07 as a nutritionist might do, you may want to actually say,
03:10 hey, it's Tuesday.
03:11 I know Tuesdays you're going to have a burrito.
03:13 This is AI.
03:13 It's doing this.
03:15 And we have this.
03:16 And maybe you want to consider this other kind of burrito
03:19 today.
03:19 Maybe you want to have an alternative,
03:21 another Mexican-tasting thing that
03:23 has more protein, more fiber, less fat and sugar for you
03:28 today.
03:29 So we can be more responsive that way.
03:30 So we can provide a lot more preventative information.
03:35 And we can offer AI Health Coach, someone who knows you,
03:39 24/7 is with you, and is going to know longitudinally
03:43 everything about you.
03:44 And it has the capacity to understand your image data,
03:48 your blood test data, your MRI data.
03:50 They can read your wearable data,
03:52 things that are not human interpretable,
03:54 AI can do for you.
03:56 So I keep reading these grim statistics
03:59 about the numbers of people with dementia,
04:02 the numbers of people with diabetes
04:03 over the next coming decades.
04:06 Sean, do you think technology is moving fast enough
04:08 to keep up with this?
04:10 Well, we are on a remarkable technology curve.
04:13 So it's really-- the tech is moving.
04:16 I think the adoption needs to move faster.
04:18 And I think the innovators up here
04:19 are all trying to make that happen.
04:21 I mean, we're-- this is the fastest tech has ever moved.
04:24 I mean, there's a new model every other day.
04:28 My bedtime routine with my kids is now to talk to AI at night.
04:31 And I keep reminding the Leta, my four-year-old,
04:33 that AI didn't exist in the way that it does now
04:36 a couple of years ago.
04:37 So I don't think the tech is the issue.
04:39 I think it's how you actually put it in practice in a way
04:41 that lands with a person, that really supports them,
04:44 that hits first principles behaviorally,
04:47 and actually gets outcomes.
04:48 And that's what needs to happen.
04:51 So Nusheen, I think a lot of people
04:53 would argue that the American job is
04:56 incompatible with health.
04:58 Can you talk a little bit about how we can bring these two
05:00 closer together?
05:01 Yes, so a lot of our jobs are sitting jobs.
05:05 So a lot of us are essentially spending--
05:10 having a sedentary lifestyle, which is, as you've heard,
05:13 sitting is the new smoking.
05:15 It's extremely, extremely dangerous
05:18 to sit for a number of reasons.
05:20 Your comorbidities go up dramatically.
05:23 So I think employers that take an interest in, for example,
05:26 treadmill desks or standing desks, people--
05:28 because now we are working remotely a lot.
05:31 So it's not like, great, offer a lot of gym subscriptions,
05:34 offer a lot of-- so we need to be really flexible,
05:36 because people are not necessarily
05:38 coming to that central location to all work together and go
05:41 to the corporate gym.
05:42 So I think the innovating companies
05:44 are providing essentially flexible ways for people
05:47 to find healthy living wherever they are,
05:50 and then contributing to the ergonomics of people's work
05:55 environments wherever they are.
05:56 And I think we need to be able to encourage people
05:59 to take vacation, for example.
06:01 And all of this needs to happen from the leadership down,
06:03 right?
06:04 We need to mean that.
06:06 And we need to not just say it, but actually live it
06:10 as leaders so that our employees can become a lot more healthy.
06:14 And it goes without saying that we should care about safety
06:17 as well, which is really a factor in a lot of jobs.
06:19 I'm going to open it up to questions in a minute,
06:21 so get your questions ready.
06:24 But Owen, I have a question for you.
06:25 So employees don't want their companies
06:27 to become big brother.
06:29 So how do we engage them, but also protect
06:32 their data and privacy?
06:35 They definitely do not want that.
06:37 But they probably want more than we think they want.
06:39 They do want a company that looks out for them
06:42 and cares about them.
06:42 And they're willing to have that company actually
06:45 make some bold decisions on their behalf.
06:47 Let me actually tell you a pretty positive story
06:50 from the last year.
06:51 Walmart, the largest private employer
06:54 that we have in the United States, one
06:56 of the largest in the world.
06:58 Now, they, over multiple years, evaluated the question
07:02 of whether they could offer zero-cost primary care
07:04 to their associates nationwide, 24 by 7,
07:07 scheduled at times that were convenient for their workplace
07:10 and their environments.
07:12 And what they saw not only was the loyalty and appreciation
07:16 of their associates, but they saw a 37% reduction
07:20 in hospital utilization and hospital stays.
07:22 That is a staggering statistic, one
07:24 that would be hard to repeat in almost any context.
07:27 Now, this was a deliberate choice by Walmart
07:30 on behalf of their associates.
07:31 They were repaid with appreciation and loyalty
07:33 in one of the hardest labor markets.
07:35 My point in telling you this story is it is doable.
07:37 We can actually have both of those things together.
07:40 We can achieve a healthier workforce
07:42 and demonstrate outstanding corporate results.
07:44 So I'm excited about that.
07:47 Do we have any questions in the audience?
07:49 I think we have one over here.
07:51 We have a microphone coming to you.
08:01 Thank you.
08:03 As a child psychiatrist, I would really
08:06 appreciate us addressing the fact
08:08 that the roots of most physical and mental chronic illnesses
08:13 begin in childhood, not only from a physical point of view,
08:17 but the impact of trauma and adversity on children.
08:21 But we have a health care system that
08:23 isn't focused on prevention.
08:26 It's focused on once the diseases happen.
08:30 And each of the exciting things you addressed
08:33 do address current chronic illnesses.
08:36 But I'd love it if you could talk
08:37 about prevention and the role of working with children
08:42 to truly change the trajectory of US health.
08:47 My answers could be quite radical, so I don't know.
08:49 I should not offer them.
08:54 Well, are you thinking of technologies
08:56 to work with children to sort of help them as they grow?
08:59 Or do you mean--
09:01 I mean really focusing on prevention,
09:05 not just treatment of chronic illnesses?
09:08 I mean, your question butts up right
09:10 against the human condition.
09:11 So children are small and by their size.
09:14 And people just assume that they don't know what they want.
09:17 And they make a lot of decisions for children.
09:19 There's a lot of things that happen.
09:21 That's how they develop trauma.
09:22 But in terms of big answers to trauma,
09:26 not necessarily preventing, but certainly I
09:29 think AI can provide mental health 24/7 therapy.
09:32 I really believe that it can.
09:35 I've seen some really, really interesting--
09:38 and also psychedelics are a big, big thing coming in.
09:42 And they will get FDA approval this year--
09:44 that I think en masse should be able to,
09:47 in conjunction with a protocol, help people
09:50 address some of their trauma.
09:52 What I would offer is when I hear prevention,
09:55 I tend to equate it with proactivity, which
09:57 is something our health care system is very bad at.
09:59 And when we talk to our members and say,
10:01 well, what did it for you?
10:03 Like, oh, well, you asked me my goals.
10:05 It's weird that health care doesn't do that.
10:07 And you were just there checking in on a regular basis,
10:10 a continual basis.
10:11 And because if you do that, if you get to know someone,
10:14 that does prevent downstream progression of a disease
10:18 and complications.
10:21 Did we have another question?
10:23 Thank Varadhan, co-founder and CEO of NanoAir.
10:30 Sean, good to see you again.
10:32 And nice to meet the rest of you.
10:34 To the last question, and maybe this is specific for you,
10:37 Sean, food and diet obviously come to mind
10:41 immediately when we think about childhood progression
10:44 into chronic disease.
10:45 How much have you tied--
10:47 over 13 years now, you've tied your solution,
10:49 which was first data-driven on a day-to-day basis,
10:53 but now I'm sure you've brought in a lot with regards
10:56 to diet and food and the services around that.
10:59 Just curious on how you're tying those things together,
11:01 and maybe the other panelists' opinions on that as well.
11:04 Yeah, I mean, I think the one lesson I'd offer--
11:06 we could probably talk for 45 minutes on this.
11:08 I think the one lesson I'd offer is if you don't really
11:11 listen to someone and really try to understand what will work
11:15 in their world, does it align with their goals,
11:17 their circumstances, their family, their preferences,
11:22 it just will not land durably.
11:24 So that's something that-- and there's
11:26 an art to figuring that out and really listening to people
11:29 and matching their truth with what can be encouraged
11:33 and kind of work for them over time.
11:35 So again, that's a distillation, but again,
11:39 I could talk for hours on that.
11:41 Can I jump in on that?
11:42 So we've been in research seven years,
11:45 and the single most accurate predictor
11:49 of people's glycemic response when
11:51 it comes to metabolic health and managing your blood sugar
11:53 is what you put in your mouth.
11:54 So food is incredibly important, more important than activity,
11:58 more important than everything else that
12:00 affects your glucose, like sleep, stress, what time of day
12:05 you eat, et cetera, because we've measured it all.
12:07 So food has an outsized role in, for example,
12:12 chronic diseases like metabolic disease,
12:14 like diabetes, which then leads to other comorbidities.
12:17 So food is really big, and we're very
12:19 excited about food as medicine picking up steam
12:23 as a movement in the country.
12:25 Right now, I think 11 states or Medicaid organizations
12:28 are now covering food as medicine,
12:30 and there are medical prescriptions being
12:32 written all over the United States.
12:33 And this movement is only going to grow.
12:35 Any other questions?
12:39 There's a microphone coming for you.
12:49 Sure, my name's Harvey Karp.
12:50 I'm a pediatrician and the CEO of Happiest Baby.
12:53 We make a robotic baby bed called SNOO.
12:57 And I wanted to just make a comment
12:59 about the health of young children and chronic disease,
13:03 because AI, fantastic, but there's some--
13:07 like nutrition, there are some more get back
13:10 to the basics in terms of improving health care.
13:12 And one of the things that we're exploring with SNOO
13:15 is, number one, if we can improve sleep and reduce
13:20 crying, which we've demonstrated,
13:21 to reduce the risk of postpartum depression.
13:25 Because we know that postpartum depression then
13:27 leads to long-lasting problems for the mother,
13:29 but also affects the child development.
13:31 But one interesting fact is that rhythmic holding and rocking
13:36 is deeply soothing for all beings.
13:40 And there's evidence that kangaroo care, for example,
13:42 that is doing that with premature babies
13:45 leads to improved brain architecture 15 years later.
13:49 And so the opportunity, perhaps, is
13:52 to introduce rhythmic stimuli as a way of improving
13:55 brain's regulatory ability and reducing the normal stress
13:59 reaction so that we're not as predisposed to stress, which
14:02 then predisposes us to chronic disease.
14:05 So just saying that there are other ways of thinking about it
14:09 to try to start at the very beginning
14:12 and improve the care.
14:13 And thousands of people now get this for free
14:15 from their employers.
14:16 It's a benefit all across the country.
14:18 I want an adult version.
14:21 Please make it.
14:24 I have a question for you, Owen.
14:27 So many employees aren't--
14:29 they're gig workers.
14:30 They're freelance workers.
14:31 They're not salaried employees.
14:34 How should we be thinking about them in terms
14:36 of caring for their chronic conditions and preventing them?
14:40 Yeah, terrific question.
14:41 Because ultimately-- just to frame the question up
14:44 a little bit more broadly, one of the things,
14:46 if you think about the payment architecture and coverage
14:48 in the United States, a lot of the problems
14:52 that we think of as the most expensive and acute--
14:54 you mentioned dementia earlier-- really actually present
14:57 after you're in the active workforce, by and large.
15:00 But the seeds, the preconditions,
15:02 are happening while you're in the commercial workforce.
15:05 So actually, investment and prevention at childhood,
15:08 at baby, is really important.
15:10 But the people who are on the payment end of it
15:12 don't actually realize that.
15:14 And I want to circle back to that in a half second.
15:16 For the gig workers specifically,
15:19 we and other companies provide benefits, for example,
15:23 to Instacart drivers to make sure
15:26 that we are providing that care.
15:27 Now, there's two good things.
15:28 One, the member gets an amazing service whenever they need it,
15:32 at low or no cost to them, to provide
15:34 high-quality virtual care.
15:35 But two, you are not passing a time bomb along later
15:39 to whoever ultimately has that full commercial insurance
15:42 responsibility.
15:42 That is really, really, really important.
15:45 I just want to briefly remark on this conversation.
15:47 By the way, Marty, your product is great.
15:49 I've seen it.
15:51 Is that I have an interest--
15:52 I think all of us have an interest
15:54 in the pediatric routes of disease and chronic disease
15:56 in this country.
15:56 But I want to be absolutely crystal clear about something
15:59 that is not actually where the money is.
16:01 And so the problem is that if you think about it, all of us,
16:05 we get rewarded in our businesses,
16:06 probably like many of you, around where you
16:09 get acute flare-ups in cost.
16:12 And so that's actually where the dollars go.
16:14 That's where the digital health innovation goes.
16:16 It actually takes a founder mindset,
16:18 like my colleagues up here, to stay in it for the long term
16:21 and say, we want to actually solve this problem a lot more
16:23 comprehensively.
16:25 I hope more of you will stay in that fight for a long time,
16:27 because health care does take a while, because then you
16:30 can take that comprehensive view of prevention.
16:32 But rarely are you rewarded for starting a business that's
16:34 focused on prevention.
16:38 All right, I have a rapid-fire question for you.
16:41 If you could answer in 30 seconds, each of you,
16:43 what is the one most important thing
16:46 that we need to do to begin to reverse this situation?
16:48 I'll start with you, Sean.
16:49 It sounds silly, but I think we need to enable payment
17:00 for asynchronous care.
17:04 Because if you think about what I shared,
17:05 the operational models needed for proactivity
17:08 require billing for asynchronous care.
17:11 So all the incentive structures, all the regulatory structures,
17:13 all the billing models-- the entire US
17:16 that created this problem of a visit-by-visit system that
17:20 doesn't work for chronic disease is because you
17:22 can't bill for async care.
17:24 So if you don't actually fix that,
17:26 you're never going to create a better experience that
17:28 could lead to better results in chronic disease.
17:32 I would say deploying AI responsibly.
17:35 I would say on a personal level, all the things
17:37 that we could do for a person to gain agency over their health,
17:40 onboard them to their health journey, and keep them there,
17:43 keep them interested and engaged.
17:44 But also for a company to manage programs,
17:48 such as challenges and campaigns, health challenges,
17:52 especially in a remote work decade that we're in right now,
17:57 it's really important to get people interested in group
18:00 activities, even if they are remote.
18:03 And there are many ways that AI can help.
18:06 It can dynamically even change incentives.
18:08 It can decide this group is doing great.
18:10 They're going to raise the bar.
18:11 AI can do incredible things for engagement and gamification.
18:14 And of course, at an even higher meta level,
18:17 corporate America can really look at trends,
18:21 look at claims data.
18:23 We can look at risk stratification.
18:25 We can see who really needs help and who
18:28 should we help preventatively.
18:30 And we can scale solutions like diabetes broadly.
18:34 And we can supercharge telemedicine.
18:36 We can do so many things with AI.
18:37 So I would say that's my one.
18:38 Thank you.
18:39 I'm so sorry we're out of time.
18:40 It was going to be really good.
18:42 You'll have to ask me later.
18:44 Going to be the best one.
18:45 Thank you so much for joining us.
18:49 [BLANK_AUDIO]